Shy-Drager syndrome is a degenerative disorder of the nervous system. Multiple areas of the nervous system can be affected, such as the parts that control motor and involuntary functions. The motor system controls movement and balance. The involuntary, or autonomic, nervous system controls body functions (for example, blood pressure, bowel and bladder function). Shy-Drager syndrome may cause postural hypotension. Postural hypotension is a drop in blood pressure after changing position that can result in dizziness or fainting.
Your doctor will ask about your symptoms and medical history, and perform a physical exam. This disease is often hard to diagnose. There is no specific test for Shy-Drager syndrome, but testing helps rule out other conditions.
Tests may include:
Blood tests—to measure electrolytes and other blood chemistries.
—a test that uses magnetic waves to make pictures of the inside of the body.
—a test that measures and records the electrical activity of the muscles at rest and when contracted. It can check for skeletal muscle weakness.
Tilt-table test—measures changes in blood pressure as your body position changes
Sleep studies—to check for disorders such as sleep apnea.
—a series of x-rays of the upper digestive tract taken after you swallow a barium substance, which will show up on x-ray. In people with Shy-Drager syndrome, this test is used to assess swallowing problems.
No cure exists for Shy-Drager syndrome. Doctors are often able to help you manage the blood pressure problem. But no treatment exists to stop the decline in nerve function. Therapies aim to control symptoms.
Treatment may include:
Options may include:
Drugs to prevent drops in blood pressure, including:
Laxatives or stool softeners to treat constipation
Drugs to treat urinary symptoms, including oxybutynin, tolterodine, or propantheline—However, these can cause worsening of the constipitation.
Drugs to treat impotence, such as yohimbine or sildenafil—Sildenafil must be used with care as it can worsen the low blood pressure that occurs with the disease, causing dizziness and fainting.
Diet and exercise guidelines include:
Increase salt and fluid to help keep blood pressure up when standing.
One recent study demonstrated that drinking about 12 ounces of tap water once daily in the early morning can decrease otherwise difficult to treat low blood pressure in multiple system atrophy.
Drink beverages containing caffeine after meals.
Eat small, frequent meals.
Eat soft foods, which may be easier to swallow.
Increase fiber to help with constipation. Avoid straining when going to the bathroom.
Avoid drinking alcoholic beverages.
Exercise only moderately. Avoid vigorous exercise.
Lifestyle modifications include:
Sleep with the head of your bed raised to help prevent drops in blood pressure when arising.
Get up slowly and change positions slowly.
Wear elastic support stockings and abdominal binders or a body suit to help maintain blood pressure.
Avoid too much heat in your home (including when bathing) or environment.
To help you manage specific symptoms and side effects:
Try speech therapy for help dealing with swallowing and speech problems.
If swallowing is a problem, ask your doctor about tube feedings.
Join a support group for patients and/or family members.
Ask your doctor about a penile implant and other treatments for impotence.
Ask your doctor about intermittent catheterization for urinary problems.
Ask your doctor before taking any drugs. Many patients with Shy-Drager syndrome are very susceptible to drug side effects even at low doses.
If you have severe breathing problems that cannot be relieved in other ways, your doctor may advise that you have a tracheostomy. This is a surgically-created hole in the windpipe, usually a treatment of last resort.
There are no guidelines for preventing Shy-Drager syndrome because the cause is unknown.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a